I'm a California girl, born and raised here, with an abiding interest in health issues and particularly, healthy aging. I have always loved working with older people, probably because I had this amazing grandmother. She taught me so much about life, balance, how to be your own person, and how to savor the moment. She was a nurse and inspired me to be one, too. I evolved into a second career, practicing law, representing individuals. Now, I'm in the advice and conflict resolution field, focused on issues about aging and aging parents. This blog is dedicated to you, the one with the aging parent or aging loved one. Maybe it's just about all of us middle aged folks getting older ourselves. My husband, Dr. Mikol Davis, a psychologist, and I put our efforts together at AgingParents.com. We've got 2, 20-something kids and an 89 year old mother in law. Helping Mom is a big part of our lives. Lots of our friends are going through the same things we are: parents starting to decline in health or alertness, putting time in with all we can do to help out. The stresses affect you, and they affect me, too. I like to discuss these challenges and what you can do to meet them. Feel free to comment!

Are We Underestimating How Much Help Aging Parents Need At Home?

Lots of people think of the possibility that their aging parents might need a little help. The parents may be struggling, but don’t want anyone coming into their home. They say “I’m fine” when their children suggest a helper. So, they all wait.

No one calculates the actual cost of help until a crisis hits. Like a fall and broken hip. After the hospital and then the rehab facility, it’s back home. Then the adult children are shocked to discover that Medicare does not cover a home care worker to be there to help mom with her bath and meal preparation. Medicare does not cover anything else that is categorized as help with “activities of daily living”.

The concern is whether the adult children are going to have to pay for that help out of their own pockets. Many aging parents do not have the income to cover this help.

The report tells us about our aging parents who have trouble functioning independently in their activities of daily living (ADLS), which include bathing, dressing, eating, toileting, walking, and transferring from bed to chair.

People with functional limitations who receive assistance from others primarily rely on informal care to obtain the assistance they need. Generally, this means family caregivers. The number of hours of paid care is highest for people who have difficulty with three or more activities of daily living and who are 85 or older. Many are widowed and thus without a spouse to care for them.

People under age 85 with limitations in three or more ADLs who live at home rather in a care facility receive an average of 9 hours of assistance per day.

People age 85 or older with that degree of impairment typically receive about 11 hours of assistance per day, mostly informal.

And for those whose aging parents 85 and up who have limitations with three or more ADLs and who also have cognitive limitations (this includes dementia) receive an average of more than 14 hours a day of informal and paid care.

The cost of an unlicensed home care worker who provides basic care is paid out of pocket for those who are not eligible for public benefits. According to the 2012 Met Life study of costs of long term care, including home care workers, the average national cost is $20 per hour.

If you pay a worker to come to your 85 year old parents’ home to care for them with three functional limitations and dementia, the cost will be an average of $102,200 per year for daily, 14 hour a day help. Since most elders cannot afford this, the writing is on the wall. Family members provide much of the needed help themselves. Will this be you?

Long term care insurance is the only private benefit that covers home help with activities of daily living, the kind of help most elders need. But most people in the U.S. don’t have it. The Congressional Budget Office report cites statistics from America’s Health Insurance Plans, Who Buys Long-Term Care Insurance in 2010–2011 (report prepared by LifePlans, March 2012), www.ahip.org/ WhoBuysLTCInsurance2010-2011/. Among the adult U.S. population only about 3 percent had LTC insurance in 2011.

It is prudent to consider the long term picture even if your aging parents are just fine at the present. Most of us are going to need some help at some time in the future if we live to be that old. Aging parents need to see their financial planners to be sure their assets are available to cover these potential costs. And if they do not have that kind of assets, be prepared for the alternatives. It may be up to you to pay or provide care on your own.

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Many have scoffed at Long Term Care Insurance as an industry “with no fix in sight”, but the truth is, LTCI helps millions of Americans each day. The industry pays out $18 million in claims each day, and a Long Term Care Insurance policy doesn’t have to be unaffordable. Long term care, on the other hand, almost always is. Denial is no longer an option as this issue begins to affect more families across the United States and there is a real need for alternative solutions to help save for retirement and pay for our care.

An independent agent can help you compare multiple companies and find the plan that best fits your specific needs and target budget. The younger you buy, the lower your rates will be, so be sure to buy as early as possible, preferably in your 40s or early 50s. If you have doubts about the cost, request a free quote. Rates vary widely, so chances are, the quote your neighbor told you won’t be the same quote you will receive. Long Term Care Insurance ensures you won’t become a burden on your family and gives you peace of mind that your assets will not be depleted due to your health.

Rachel: Thank you for your comments. It is true that LTCi does help millions of people. I bought it myself. See the article “Hidden Truths About Long Term Care Insurance” next to this one. However, let’s be truthful about the downside. You said

“Long Term Care Insurance ensures you won’t become a burden on your family and gives you peace of mind that your assets will not be depleted due to your health.”

No, it doesn’t ensure that you won’t become a burden. If you have enough assets to buy the most expensive policy, maybe it will reduce the burden. You can’t honestly tell anyone their assets won’t be depleted even with this insurance. It may only be good for 2 or 3 years if that’s what the policy holder could afford to buy. Alzheimer’s Disease, just for one example, can last for 20 years. LTCi is an investment that helps protect against risk, and nothing more. It is not a fix for all the financial and other problems of getting old and sick. Even with it, chronically ill people are indeed a burden on their families. Let’s stick with no exaggeration in comments about this kind of product.

Caroline, You are right to say my statement was an exaggeration, as there is no way to 100% ensure you won’t become a burden or deplete your assets. Instead, I should have written “LTCI can *help* reduce the burden and *help* cover the costs”. However, I did not intend my statement to be an exaggeration, but rather a statement based on the average American LTC experience.

While it’s true Alzheimer’s can last for more than 20 years, this is not the norm. More than 90% of long term care cases last 3 years or less, so for the average policyholder, an LTCI plan with a 2 or 3 year benefit period may be able to cover almost all of the costs (minus the elimination period). If you are unfortunate enough to need care for a much longer period and have not purchased an applicable benefit period, you will need to find another way to pay for care, either out of pocket or via Medicaid.

You are correct, again, to say that long term care patients will still be a burden to their family regardless of how they are paying for care, but the burden will likely be drastically reduced with LTCI. There is an extremely disturbing trend of unpaid care in this country, so if we could even eliminate some of the unpaid care via LTCI, that familial burden would be significantly reduced. I appreciate you taking the time to respond to comment and hope more people begin to see the advantages of early planning for long term care.

Thank you Rachel. Indeed planning ahead is not our society’s strength when it comes to long term care. There are a lot of reasons why LTCi is not popular and that as of 2010, only 2% of the population had it. Trying to convince people to buy it is not easy I’m sure.

Just saw story today from Baltimore; handymen outfitting elderly homes with tools, gear, equipment so they can age at home and not long-term care facilities. I like this and hope when I need to consider this time of life, my home will be set up this way.

People cannot afford long-term care insurance nor can they turn over their assets to these facilities.

These issues will continue to unfold as cities (recent Money magazine) begin to orient infrastructure to an aging population.

Jayme: Most people do in fact prefer to age in place at home. Outfitting a home to accommodate one’s physical needs is one thing. Planning for how to bring in enough help to manage cognitive changes is yet another. No matter how well a home is set up, if you can’t remember how to cook or you forget your medicine, you need caregiving. That is what this post was about–it costs money or the family has to provide it. Thanks for your comment.

Barry: Assisted living is a good alternative for some people. It can also be very expensive. You pay a basic fee for the rent and meals, but you have to pay extra for every element of care in the larger assisted living facilities. (Smaller “mom and pop” homes are often different). Many also charge an up-front “community fee” which can be quite large and is unaffordable for aging parents of modest means.

While it is not polite no child has to pay for the care of their parents, many won’t be able to pay and some will actually help as they can. The insurance is way too expensive and not a good deal for almost anybody.

Barry: A lot of people agree with your comments. Many think this insurance is way too expensive. Some products are less so, but in order to use them, the insured has to pay out of pocket for expensive care to meet the “elimination period”, which is a large deductible. It can be thousands of dollars just for that. It is controversial. Thank you for your comments.

Now that 40 states have “LTC Partnership programs” you do not have to buy an expensive “unlimited” long-term care insurance policy. You only need to buy an amount of long-term care insurance equal to the amount of assets you want to protect for yourself, your spouse or partner, and/or your heirs.

These government-approved policies are like a traditional long-term care policy with additional consumer protection features.

Yes, Joyce these partnership programs do work. However, you do not mention the concerns of other commentors, that one must pay for the monthly premiums for $400,000 worth of coverage, which could be over many many years. and then pay the out of pocket deductible, or “elimination period” costs, which could also be thousands of dollars each month for as long as the elimination period lasts, often 90 days at least. Some people just can’t afford it. They aren’t worried about qualifying for Medicaid. They will anyway because they can’t afford to pay out of pocket for care without running out of money. Thank you for mentioning the partnerships, as they are good for people with decent income who can pay the premiums for 25 or 30 years.

Your information is very interesting. In my opinion, most people do not realize that their parents may need help. It is hidden well by them, because of thoughts of unknown people coming into their homes or the fear of being a burden on family members and the fear of change or the unknown. Growing old is a scary business for most. Many things that could happen may bring unexpected or unwanted results for the older parents. With the real odds against them in regards to staying healthy and independent, many older adults compromise what they do or let on about their lives. They will not mention the slip in the tub, or the lack of food in the house because they cannot get around as well as they used to. Adult children must take a fresh look at how their parents really are. I have a fifty something friend with a PHD who sees her parents slowing and starting to fail,but will not visit the idea of talking to them about not driving. I responded with ” If your teenaged son presented with these behaviors, would you let him drive?” Of course the answer is no. The response times are tremendously slow and real time logic is skewed by TIAs or strokes. To her, they are her parents and she cannot stand up to them. She also wants to believe that they are still “ ok”. These roles that adult children are entrenched in make addressing these issues even harder to handle. As always education is the key to promoting guidelines for evaluating older people’s functioning, hopefully before an unwanted event happens.

Sue, thank you for your very insightful and thoughtful comments. You are absolutely right in your observations. A big part of the problem is unwillingness by adult children to stand up to their parents. You said, “As always education is the key to promoting guidelines for evaluating older people’s functioning, hopefully before an unwanted event happens.” I agree. In this blog and at my work at AgingParents.com, I try to provide that education through books, a newsletter, YouTube videos and webinars. Our work is never done! Thank you for responding.